A number of months ago I discharged a patient to a physical rehabilitation center. This is pretty common, and it seems especially so in internal medicine, where there is a large proportion of old patients with multiple problems complicated by poor physical condition.
Mr. Sigursson was not happy about going to this place though. I had tried to walk him around the ward, and he got short of breath just getting out of bed. He was too deconditioned to brush his teeth. But his wife had died six months before in a similar institution, and as he expressed at length to me: "I'm 93 years old, I've been an elder in my church, I've founded charitable organizations, I've done all the fishing I'll ever do, and now I've sold my house, my boat, and everything else that I used to do to live in an assisted living apartment. I'm done with life, why the hell do I need rehab?"
In short, he was ready to join his wife.
Honestly, I didn't know that rehab would do him any good. He was pretty sad, and he had great reasons for being so. He wasn't motivated to succeed with physical therapy, and as he said, he had little to look forward to once he got out. I always feel a little out of place, being 27 and telling people nearly four times my age that "there's a lot left to live for."
So it was with great pleasure, and not a little amusement, that I saw him at the grocery store today, pulling his walker out of the bed of his pickup truck without lowering the tailgate.
He was smiling.